秋燥汗出不解,口大渴,日晡发热,清晨则凉,
状虽如疟,而无寒战,此瘅疟也。宜用西参、生地、
麦冬,百膏、知母、花粉、青蒿、甘草、粳米等味,
甘寒养阴也。
按(金柜)云,阴气先伤,阳气独发,但热无寒,是名
瘅疟。主以饮食消息之,而并未注方。至喻嘉言,悟出甘凉
濡润,以养胃阴之义,与饮食消息之意恰合,故用人参白虎
汤,甘寒养正,又佐花粉、清蒿,清金泄木,为法中之法
焉。
秋燥汗多不解,每临午后,寒微热甚,烦闷欲
呕,舌赤脉洪,此温疟也。宜用桂枝白虎汤加杏仁、
厚朴,呕则加半夏、茯苓等味,两清表里也。
按(金柜)云:微寒多热,烦闷欲呕,骨节疼痛,是名
温疟,用桂枝白虎汤(1)。其方下自注云:一剂知,二剂巳(2)。
盖言汗多则表邪既微,故寒少;烦呕,则内燥已甚,故热
多。是病在肺之表里,用白虎以清内热,合桂枝引邪出表,
加杏、朴疏通内滞,半夏变和阴阳。所谓一剂知,则已知其
确中病情;二剂已,则病必霍然矣。
秋燥日久不解,误补邪留,消烁肺金,咳痰浓
(1)桂枝白虎汤,(金柜·疟病脉证并治第四)原方名,'白虎加桂枝汤'。
(2)其方下自注云:一剂知、二剂巳,今本《金柜·虐病脉证并治第四)白
虎加桂枝汤下无此注。
浊,甚唾脓血,胸间版痛,此肺萎也。宜用苇茎汤
加瓜蒌、杏仁、桑皮、桔梗、百合、川贝等味,清
肺祛浊也。
凡炽燥热之症,重则果易辨明,轻则淹淹发热,喉燥咳
逆。若误认阴虚而投滋补,则邪无出路,逗留肺内,炎炎熏
灼,肺阴日损,以致咳唾浊痰,继出脓血,与肺痛似是而
非,故《金柜》称为肺萎。盖廱则属实,萎则属虚,故用苇
茎汤合瓜蒌、杏、贝,桑、桔、百合,宣通肺气,以化其瘀
腐败浊。俾肺热得清,呼吸无阻,而病可渐瘳也。
秋燥病出现汗出后症状未缓解,口中极度口渴,下午申时(15:00-17:00)发热,清晨则体温正常或偏凉,
症状虽然类似疟疾,但没有寒战,这是瘅疟(一种但热不寒的疟疾)。适宜使用西洋参、生地黄、
麦冬、白蜜、知母、天花粉、青蒿、甘草、粳米等药物,采用甘寒之法滋养阴液。
按语:《金匮要略》记载,阴气先受损,阳气独自亢盛发作,只有发热没有恶寒,这叫做
瘅疟。主张通过饮食调理来观察病情变化,但并未注明具体方剂。到了喻嘉言,领悟出甘凉
滋润以养胃阴的道理,与饮食调理之意恰好吻合,因此使用人参白虎汤,用甘寒之法扶助正气,又佐以天花粉、青蒿,清泄肺金之热并疏泄肝木之火,这是治法中的治法。
秋燥病出汗多且症状未缓解,每逢午后,轻微恶寒而发热严重,心中烦闷想要
呕吐,舌质红赤,脉象洪大,这是温疟(一种热多寒少的疟疾)。适宜使用桂枝白虎汤加杏仁、
厚朴,如果呕吐则加入半夏、茯苓等药物,表里双清。
按语:《金匮要略》记载:轻微恶寒而发热重,烦闷欲呕,骨节疼痛,这叫做
温疟,使用桂枝白虎汤。该方下方自注说:服一剂见效,服两剂痊愈。
大概意思是说,出汗多则表邪已经轻微,所以恶寒少;烦闷呕吐,则体内燥热已经很严重,所以发热多。此病位于肺的表里之间,用白虎汤清解内部热邪,配合桂枝引导邪气从体表排出,
加入杏仁、厚朴疏通内部气机阻滞,半夏调和阴阳。所谓“一剂知”,就是知道药已确切击中病情;“二剂已”,说明病一定会迅速痊愈。
秋燥病日久未愈,误用补益药物导致邪气滞留,消耗灼伤肺金,咳嗽痰液浓
稠浑浊,严重时咳吐脓血,胸部剧烈疼痛,这是肺痿(肺部萎弱不用的虚损性疾病)。适宜使用苇茎汤
加瓜蒌、杏仁、桑白皮、桔梗、百合、川贝母等药物,清肺祛浊。
凡是炽热燥热的病症,重的容易辨别清楚,轻的则是持续低热,咽喉干燥咳嗽气逆。如果误认为是阴虚而投用滋补药物,则邪气没有出路,逗留于肺内,火热熏灼,肺阴日渐损耗,以致咳嗽吐出浊痰,随后出现脓血,这与肺痈(肺部化脓性病变)看似相似实则不同,所以《金匮要略》称之为肺痿。大概因为痈属于实证,痿属于虚证,所以使用苇茎汤合瓜蒌、杏仁、贝母,桑白皮、桔梗、百合,宣通肺气,以化解瘀积腐败的浊物。使得肺热得以清除,呼吸无阻碍,疾病便可逐渐痊愈。
When autumn-dryness disease presents with sweating that fails to resolve symptoms, extreme thirst in the mouth, fever during the Shen hour (15:00–17:00), and coolness or normal temperature in the early morning,
although the presentation resembles malaria (a febrile disease characterized by alternating chills and fever), there is no chiller stage. This is termed Dan Malaria (a type of malaria characterized by heat without chills). It is appropriate to use Xi Shen (Western Ginseng, *Panax quinquefolius*), Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Bai Gao (White Honey), Zhi Mu (Anemarrhenae Rhizoma), Hua Fen (Trichosanthis Radix), Qing Hao (Artemisiae Annuae Herba), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Jing Mi (Oryzae Sativa Granum), employing a sweet and cold method to nourish Yin fluids.
Commentary: The *Jin Gui Yao Lue* states that when Yin Qi is damaged first and Yang Qi acts alone in hyperactivity, resulting in heat without chills, it is named Dan Malaria. It advocates managing the condition through dietary adjustments but does not specify a formula. Later, Yu Jiayan realized the principle of using sweet-cool moistening agents to nourish Stomach Yin, which aligns perfectly with the intent of dietary management. Therefore, he employed Renshen Baihu Tang (Ginseng White Tiger Decoction) to support healthy Qi with sweet-cold properties, assisted by Hua Fen and Qing Hao to clear Lung Metal heat and drain Liver Wood fire, representing a method within the method.
In autumn-dryness disease, excessive sweating fails to resolve symptoms; every afternoon, there is slight chills but severe fever, mental restlessness, and a desire to vomit, with a red tongue and a surging pulse. This is Wen Malaria (a type of malaria characterized by more heat than chills). It is appropriate to use Guizhi Baihu Tang (Cinnamon Twig White Tiger Decoction) added with Xing Ren (Armeniacae Semen Amarum) and Hou Po (Magnoliae Officinalis Cortex); if vomiting occurs, add Ban Xia (Pinelliae Rhizoma) and Fu Ling (Poria) among other ingredients, to clear both the exterior and interior.
Commentary: The *Jin Gui Yao Lue* states: slight chills with predominant heat, mental restlessness, desire to vomit, and pain in the bone joints constitute Wen Malaria, treated with Guizhi Baihu Tang. The note under this formula states: "One dose brings improvement, two doses bring cure."
This implies that because of excessive sweating, the pathogenic factor on the exterior is mild, hence few chills; because of restlessness and vomiting, internal dryness-heat is severe, hence more heat. The disease involves the exterior and interior of the Lung. Baihu Tang clears internal heat, combined with Guizhi to guide pathogens out from the exterior. Added Xing Ren and Hou Po unblock internal stagnation, while Ban Xia harmonizes Yin and Yang. "One dose brings improvement" indicates the medicine accurately targets the pathology; "two doses bring cure" suggests the illness will be rapidly resolved.
If autumn-dryness disease persists for a long time without resolution, and mistaken tonification causes pathogens to linger, consuming and scorching Lung Metal, leading to cough with thick,
turbid sputum, and in severe cases, expectoration of pus and blood, accompanied by severe chest pain, this is Fei Wei (Lung Flaccidity, a deficiency syndrome of lung atrophy). It is appropriate to use Weijing Tang (Eupatorium Decoction) added with Gua Lou (Trichosanthis Fructus), Xing Ren, Sang Bai Pi (Mori Cortex), Jie Geng (Platycodonis Radix), Bai He (Lilii Bulbus), and Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), to clear the Lung and eliminate turbidity.
For conditions of intense dryness-heat, severe cases are easy to identify clearly, while mild cases present as lingering low-grade fever, dry throat, cough, and rebellious Qi. If mistakenly diagnosed as Yin deficiency and treated with tonifying herbs, the pathogen has no exit, lingers in the Lung, and burns fiercely, causing daily depletion of Lung Yin. This leads to coughing up turbid sputum, followed by pus and blood. Although similar to Fei Yong (Lung Abscess), it is distinct; thus, the *Jin Gui* calls it Fei Wei. Generally, Yong belongs to excess syndromes, while Wei belongs to deficiency syndromes. Therefore, Weijing Tang combined with Gua Lou, Xing Ren, Bei Mu, Sang Bai Pi, Jie Geng, and Bai He is used to promote the free flow of Lung Qi to transform stasis and rotting turbidity. This allows Lung heat to be cleared and respiration to be unobstructed, so the illness can gradually improve.